Human Errors & Med School

[JustLookingforAnswers]

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Greetings, everyone!

I read online a report not too long ago that claimed that Human Medical Errors was the #3rd cause of death in the United States.

Although we are all prone to mistakes considering no one is perfect, doesn't anyone find this concerning? I am not in med school by any means, but many former and current med students have told me that in med school that they throw so much info out at you that it's impossible to know all of it. As a result, students make themselves sick due to anxiety and are more predisposed towards developing depression, thus, hindering academic and mental performance. The saying "one week of med school is equivalent to one undergraduate semester" is agreed upon by many med students. By what these students are telling me about how much hell it all is, how is that even doable? I get people's lives are on the lines, but how can someone properly retain all of this information when they have little time to absorb it? Maybe this is the issue contributing towards human medical errors? Thoughts?

 

[Foot Fetish]

Just an M1 here, but, from what I understand, people generally retain the nitty gritty basic science info until Step 1. Then they purge it. In reality, most of your working knowledge will be acquired during residency and will be specific to your specialty. The vast majority of minutia you learn in medical school will be forgotten because it simply will be irrelevant to your scope of practice. For example, there is absolutely no reason why a psychiatrist needs to know the brachial plexus.

 

[JustLookingforAnswers]

Just an M1 here, but, from what I understand, people generally retain the nitty gritty basic science info until Step 1. Then they purge it. In reality, most of your working knowledge will be acquired during residency and will be specific to your specialty. The vast majority of minutia you learn in medical school will be forgotten because it will simply be irrelevant to your scope of practice.

Oh, ok. That makes sense.

Good luck in your career! I hope M1 isn't too bad and hopefully you're doing good. You can do it, keep plugging away! 🙂

 

[Tenk]

A lot of those "studies" have a very loose interpretation of what human error means if you actually read the inclusion criteria. Yes, errors exist and improvements can always be made but don't let gloom and doom reports scare you off.

 

[Goro]

Well, good students manage to do it. Repetition is the key to learning. And most of the brute memory stuff goes into the building blocks of medical knowledge. In your clinical years, you learn the doing of Medicine. In your residency, you hone your craft.


Medical mistakes aren't because people forget stuff.

I get people's lives are on the lines, but how can someone properly retain all of this information when they have little time to absorb it?

 

[JustLookingforAnswers]

Well, good students manage to do it. Repetition is the key to learning. And most of the brute memory stuff goes into the building blocks of medical knowledge. In your clinical years, you learn the doing of Medicine. In your residency, you hone your craft.


Medical mistakes aren't because people forget stuff.

I get people's lives are on the lines, but how can someone properly retain all of this information when they have little time to absorb it?

A lot of those "studies" have a very loose interpretation of what human error means if you actually read the inclusion criteria. Yes, errors exist and improvements can always be made but don't let gloom and doom reports scare you off.

Thanks for the clarification guys.

I wish you all well.

 

[Entadus]

Just an M1 here, but, from what I understand, people generally retain the nitty gritty basic science info until Step 1. Then they purge it. In reality, most of your working knowledge will be acquired during residency and will be specific to your specialty. The vast majority of minutia you learn in medical school will be forgotten because it simply will be irrelevant to your scope of practice. For example, there is absolutely no reason why a psychiatrist needs to know the brachial plexus.

Your willingness to participate in the community is commendable but I would be careful not to display your ignorance so forwardly. For example I am currently rotating on a Consult-Liaison psychiatry service in a medical hospital and we are frequently consulted on Somatic complaints/Somatoform disorders like Conversion disorder, somatization disorder, etc. Does the pt's "neurologic sx" actually conform to the territory of any particular nerve? Does the pt have focal neurolgic deficits? Of course there's no need to have the intricacies of the brachial plexus memorized, but the concepts and overall picture of the major nerves absolutely needs to be within a psychiatrist's working knowledge.

 

[JustLookingforAnswers]

Your willingness to participate in the community is commendable but I would be careful not to display your ignorance so forwardly. For example I am currently rotating on a Consult-Liaison psychiatry service in a medical hospital and we are frequently consulted on Somatic complaints/Somatoform disorders like Conversion disorder, somatization disorder, etc. Does the pt's "neurologic sx" actually conform to the territory of any particular nerve? Does the pt have focal neuralgic deficits? Of course there's no need to have the intricacies of the brachial plexus memorized, but the concepts and overall picture of the major nerves absolutely needs to be within a psychiatrist's working knowledge.

Good luck in your career as well!

Just one question: medical school is obviously not only the most challenging educational institutions, but also the most stressful. How do you deal with constant stress (if you experience any)? When things seem impossible, how did you overcome them? How did you overcome doubt?

Also - does school come naturally to you?

Sorry if I am asking many questions, but I really want to know because medical students are very high achieving!

 

[Psai]

Greetings, everyone!

I read online a report not too long ago that claimed that Human Medical Errors was the #3rd cause of death in the United States.

Although we are all prone to mistakes considering no one is perfect, doesn't anyone find this concerning? I am not in med school by any means, but many former and current med students have told me that in med school that they throw so much info out at you that it's impossible to know all of it. As a result, students make themselves sick due to anxiety and are more predisposed towards developing depression, thus, hindering academic and mental performance. The saying "one week of med school is equivalent to one undergraduate semester" is agreed upon by many med students. By what these students are telling me about how much hell it all is, how is that even doable? I get people's lives are on the lines, but how can someone properly retain all of this information when they have little time to absorb it? Maybe this is the issue contributing towards human medical errors? Thoughts?

No because the way they did it was to look at 4 small studies, one of which looked at another one of the included studies at small hospitals and they extrapolated that to the entire united states and then added a huge fudge factor, like 50%, by saying that errors are underreported. So no, I don't believe in that statistic at all.

 

[ERDOC555]

Good luck in your career as well!

Just one question: medical school is obviously not only the most challenging educational institutions, but also the most stressful. How do you deal with constant stress (if you experience any)? When things seem impossible, how did you overcome them? How did you overcome doubt?

Also - does school come naturally to you?

Sorry if I am asking many questions, but I really want to know because medical students are very high achieving!

Honestly medical school is pretty stressful in general, but varies greatly depending on your school and desired specialty. Some schools are really intense (close to 35-40 hours of class time per week), while others are super chill (half days, 20-25 hours per week). Also just passing (70%) is pretty easy at the vast majority of schools, hence the low drop out rate. However for those gunning for competitive specialties: studying hard, remembering minutiae, and constantly performing at maximum adds a whole lot of stress and time to pre-clinical classes.

You kind of just get used to the constant stress. Personally I have a lot of good days and a lot of bad days. I think the best way to get through it is to just push through those bad days. Medical school will destroy you if you get behind and you can't afford to sulk or take a week off. Most people who get into medical school are (hopefully) used to dealing with a good amount of stress from college, working, extracurriculars, and classes, and can handle the increase in work and stress.

I'm only a few months in so I can't comment on 3rd and 4th year, but it seems like the first 2 years are really just a lot of studying and putting in the time to learn the copious amounts of material as well as possible. It's just a grind and eventually you get through to third year (which apparently is much more time consuming and stressful)

 

[cbrons]

In reality, most of your working knowledge will be acquired during residency and will be specific to your specialty.

It's a lot more relevant than you think bud. Physicians who don't know basic physiology are no better than mid-levels, and in fact are quite dangerous.

If you don't have an intimate understanding of basic concepts like Static vs. Dynamic pulmonary pressure, Work of breathing, etc. you ain't never gunna understand mechanical ventilation. Don't understand the determinants of cardiac output, you end up like the resident who killed someone with acute MI and severe AS by giving them the protocolized beta blockers and nitrates . You don't understand renal or gastro phys, you will be like the ER NP who tried treating a K+ of 8.1 with "stat Kayexalate". Yeah pal, not knowing simple physiology = you killing people with your stupidity. There's a reason you learn that stuff and it's not for simple amusement.

 

[boshtrich]

In general there are also many levels in place in almost any hospital system to prevent medical student errors from reaching a patient. You'll likely hear about the Swiss cheese model for medical errors meaning that the majority of medical errors are a result of system failures as opposed to a single medical student error. As a medical student, everything you do should theoretically be checked by a resident which then should be checked by an attending. Orders also generally need to be verified by nursing and pharmacy. This creates multiple checkpoints that any decision must be approved prior to reaching a patient. Medical error often occurs when gaps in system align to allow a mistake to make it past several levels of checking and double checking. Most systems make it difficult for decisions made by medical students to reach patients without being verified by several other people. Combine this with the fact that as a medical student I was generally terrified to make any real plans without input from someone who knew more than me and you have relatively low risk of making a serious medical error as a student.

 

[cbrons]

In general there are also many levels in place in almost any hospital system to prevent medical student errors from reaching a patient. You'll likely hear about the Swiss cheese model for medical errors meaning that the majority of medical errors are a result of system failures as opposed to a single medical student error. As a medical student, everything you do should theoretically be checked by a resident which then should be checked by an attending. Orders also generally need to be verified by nursing and pharmacy. This creates multiple checkpoints that any decision must be approved prior to reaching a patient. Medical error often occurs when gaps in system align to allow a mistake to make it past several levels of checking and double checking. Most systems make it difficult for decisions made by medical students to reach patients without being verified by several other people. Combine this with the fact that as a medical student I was generally terrified to make any real plans without input from someone who knew more than me and you have relatively low risk of making a serious medical error as a student.

Medical students are not killing patients.

ANd your line about attendings double-checking every order the residents make before carried out by nursing must be unique to your specific program, cause that ain't going on at every place (least for IM).

 

[boshtrich]

It's a lot more relevant than you think bud. Physicians who don't know basic physiology are no better than mid-levels, and in fact are quite dangerous.

If you don't have an intimate understanding of basic concepts like Static vs. Dynamic pulmonary pressure, Work of breathing, etc. you ain't never gunna understand mechanical ventilation. Don't understand the determinants of cardiac output, you end up like the resident who killed someone with acute MI and severe AS by giving them the protocolized beta blockers and nitrates . You don't understand renal or gastro phys, you will be like the ER NP who tried treating a K+ of 8.1 with "stat Kayexalate". Yeah pal, not knowing simple physiology = you killing people with your stupidity. There's a reason you learn that stuff and it's not for simple amusement.

Couldn't agree more with this. It's easy to write off anatomy, physiology and pharmacology as random knowledge for Step 1, but the ability to take an understanding of these things and apply them to a sick patient in a critical situation are what separates physicians from midlevels. And the foundation of that comes from medical school. Residency is a busy time to try a relearn basic physiology and pharmacology. Working knowledge will be gained during residency, but you need a strong foundation to take full advantage of it.

 

[boshtrich]

Medical students are not killing patients.

ANd your line about attendings double-checking every order the residents make before carried out by nursing must be unique to your specific program, cause that ain't going on at every place (least for IM).

I'm just saying that in general no medical student order is going to make it to a patient un-checked. Resident orders are an entirely different discussion. Not trying to getting into patient safety errors related to residents. Countless GME conferences could be had about that.

 

[wholeheartedly]

After working for quite a few years in health care, including participating on my area's event management team ( reviews bad or potentially bad stuff to determine root cause/prevention etc) I can say that most of the major issues that we reviewed were a result of failures at multiple points (previously mentioned swiss cheese model) often relating to miscommunications, or due to people intentionally deviating from the proper protocol take shortcuts/make their lives easier, arragonce or people thinking they know better or not knowing their limits or being willing to admit they don't know something is also an issue.

A lot of diagnostic mistakes seem to come from cognitive errors that aren't really related to lack of knowledge. Check out the book "how doctors think" by Jerome Groopman for a great read on the topic.

 

[Zebra Hunter]

It's a lot more relevant than you think bud. Physicians who don't know basic physiology are no better than mid-levels, and in fact are quite dangerous.

If you don't have an intimate understanding of basic concepts like Static vs. Dynamic pulmonary pressure, Work of breathing, etc. you ain't never gunna understand mechanical ventilation. Don't understand the determinants of cardiac output, you end up like the resident who killed someone with acute MI and severe AS by giving them the protocolized beta blockers and nitrates . You don't understand renal or gastro phys, you will be like the ER NP who tried treating a K+ of 8.1 with "stat Kayexalate". Yeah pal, not knowing simple physiology = you killing people with your stupidity. There's a reason you learn that stuff and it's not for simple amusement.

http://www.annemergmed.com/article/S0196-0644(15)00234-6/abstract

Physio is cool and stuff, but I prefer evidence over physiology that rarely ever works as clearly in the real world as it is taught in med school.

 

[boshtrich]

After working for quite a few years in health care, including participating on my area's event management team ( reviews bad or potentially bad stuff to determine root cause/prevention etc) I can say that most of the major issues that we reviewed were a result of failures at multiple points (previously mentioned swiss cheese model) often relating to miscommunications, or due to people intentionally deviating from the proper protocol take shortcuts/make their lives easier, arragonce or people thinking they know better or not knowing their limits or being willing to admit they don't know something is also an issue.

A lot of diagnostic mistakes seem to come from cognitive errors that aren't really related to lack of knowledge. Check out the book "how doctors think" by Jerome Groopman for a great read on the topic.

An excellent read. And this will only continue to become a more and more important topic in medicine.

 

[cbrons]

http://www.annemergmed.com/article/S0196-0644(15)00234-6/abstract

Physio is cool and stuff, but I prefer evidence over physiology that rarely ever works as clearly in the real world as it is taught in med school.

Agree that evidence is preferable to outdated physiology. But so-called "evidence" often conflicts with common sense and well-proven physiologic concepts. It takes an understanding of both to really come up with a reasonable decision on what is applicable in real human patients.

 

[Zebra Hunter]

Agree that evidence is preferable to outdated physiology. But so-called "evidence" often conflicts with common sense and well-proven physiologic concepts. It takes an understanding of both to really come up with a reasonable decision on what is applicable in real human patients.

I pretty much agree with you, but understand that much of this "common sense" and "well-proven physiologic concepts" are neither well-proven nor common sense outside of the dogma inundated culture of medical education. Examples: Contrast induced nephropathy, secondary intention wound healing for abscess drainage, lidocaine w/ epinephrine use in digits, avoiding calcium in digoxin toxicity, giving opiates in undifferentiated abdominal pain, tocolytics in premature labor, ....the list goes on. A good doc not only knows these proposed concepts of physiology, but, more importantly, frequently evaluates the available literature to determine whether there is any good evidence for the dogma, or whether it is all based on incompletely understood physiologic concepts or a 50 year old case series.

 

[Foot Fetish]

It's a lot more relevant than you think bud. Physicians who don't know basic physiology are no better than mid-levels, and in fact are quite dangerous.

If you don't have an intimate understanding of basic concepts like Static vs. Dynamic pulmonary pressure, Work of breathing, etc. you ain't never gunna understand mechanical ventilation. Don't understand the determinants of cardiac output, you end up like the resident who killed someone with acute MI and severe AS by giving them the protocolized beta blockers and nitrates . You don't understand renal or gastro phys, you will be like the ER NP who tried treating a K+ of 8.1 with "stat Kayexalate". Yeah pal, not knowing simple physiology = you killing people with your stupidity. There's a reason you learn that stuff and it's not for simple amusement.

Your willingness to participate in the community is commendable but I would be careful not to display your ignorance so forwardly. For example I am currently rotating on a Consult-Liaison psychiatry service in a medical hospital and we are frequently consulted on Somatic complaints/Somatoform disorders like Conversion disorder, somatization disorder, etc. Does the pt's "neurologic sx" actually conform to the territory of any particular nerve? Does the pt have focal neurolgic deficits? Of course there's no need to have the intricacies of the brachial plexus memorized, but the concepts and overall picture of the major nerves absolutely needs to be within a psychiatrist's working knowledge.

I'm not saying a fundamental understanding of anatomy and physiology isn't helpful and indeed oftentimes required for certain aspects of medicine, but the fact of the matter is that a large portion of the details you don't use in your day-to-day practice will be pruned away over the years as a physician. There's simply no way around it. You even said it yourself, @cbrons, a physician must know, at a baseline, SIMPLE physiology...Of course we will all know about gas exchange and basic hemodynamics, but virtually nobody will remember that UDP-glucoronosyl-transferase converts unconjugated bilirubin albumin complex to conjugated bilirubin. Unless you're some kind of Rainman, there's no way in hell you're remembering that stuff as an attending...because 99% of the time, there is simply no need. That's all that I'm trying to convey to our friend, @JustLookingforAnswers . You don't need to know EVERYTHING. Just because you had to memorize it at one point doesn't mean that you will be risking people's lives by not retaining it indefinitely. Hell, I bet a lot of surgeons even forget some of the basics of medicine after decades of cutting, and guess what? It doesn't really matter. If you have a super specialized scope of practice where you are just doing this one type of surgery day in and day out, you can safely forget 75% of the crap you at one point crammed into your brain for Step 1.

 

[cbrons]

I'm all about Bayes' theorem, but much of this "common sense" and "well-proven physiologic concepts" are neither well-proven nor common sense outside of the dogma inundated culture of medical education. Examples: Contrast induced nephropathy, secondary intention wound healing for abscess drainage, lidocaine w/ epinephrine use in digits, avoiding calcium in digoxin toxicity, giving opiates in undifferentiated abdominal pain, tocolytics in premature labor, ....the list goes on. A good doc not only knows these proposed concepts of physiology, but, more importantly, frequently evaluates the available literature to determine whether there is any good evidence for the dogma, or whether it is all based on incompletely understood physiologic concepts or a 50 year old case series.

Again, I agree with you. My area of research involves fluid dynamics and the microcirculation. How annoyed do you think I was to learn that they are still teaching the Starling model? All it means is that those outdated concepts need to be updated.

 

[cbrons]

I'm not saying a fundamental understanding of anatomy and physiology isn't helpful and indeed oftentimes required for certain aspects of medicine, but the fact of the matter is that a large portion of the details you don't use in your day-to-day practice will be pruned away over the years as a physician. There's simply no way around it. You even said it yourself, @cbrons, a physician must know, at a baseline, SIMPLE physiology...Of course we will all know about gas exchange and basic hemodynamics, but virtually nobody will remember that UDP-glucoronosyl-transferase converts unconjugated bilirubin albumin complex to conjugated bilirubin. Unless you're some kind of Rainman, there's no way in hell you're remembering that stuff as an attending...because 99% of the time, there is simply no need.

YOu are using ridiculous examples to make your point. Knowing the name of a specific enzyme =/= knowing the difference between conjugated and unconjugated bilirubin.

 

[boshtrich]

I'm not saying a fundamental understanding of anatomy and physiology isn't helpful and indeed oftentimes required for certain aspects of medicine, but the fact of the matter is that a large portion of the details you don't use in your day-to-day practice will be pruned away over the years as a physician. There's simply no way around it. You even said it yourself, @cbrons, a physician must know, at a baseline, SIMPLE physiology...Of course we will all know about gas exchange and basic hemodynamics, but virtually nobody will remember that UDP-glucoronosyl-transferase converts unconjugated bilirubin albumin complex to conjugated bilirubin. Unless you're some kind of Rainman, there's no way in hell you're remembering that stuff as an attending...because 99% of the time, there is simply no need. That's all that I'm trying to convey to our friend, @JustLookingforAnswers . You don't need to know EVERYTHING. Just because you had to memorize it at one point doesn't mean that you will be risking people's lives by not retaining it indefinitely. Hell, I bet a lot of surgeons even forget some of the basics of medicine after decades of cutting, and guess what? It doesn't really matter. If you have a super specialized scope of practice where you are just doing this one type of surgery day in and day out, you can safely forget 75% of the crap you at one point crammed into your brain for Step 1.

I'd also argue that while it's undoubtable that much of what is taught in medical school will likely be forgotten, it's also impossible for the average med student to know at that time what is relevant and what is not. I think the moral of the story is to not discount the basic science information you gain as a medical student as it could become more important than you expect as a practicing clinician.

 

[njtrimed]

After working for quite a few years in health care, including participating on my area's event management team ( reviews bad or potentially bad stuff to determine root cause/prevention etc) I can say that most of the major issues that we reviewed were a result of failures at multiple points (previously mentioned swiss cheese model) often relating to miscommunications, or due to people intentionally deviating from the proper protocol take shortcuts/make their lives easier, arragonce or people thinking they know better or not knowing their limits or being willing to admit they don't know something is also an issue.

A lot of diagnostic mistakes seem to come from cognitive errors that aren't really related to lack of knowledge. Check out the book "how doctors think" by Jerome Groopman for a great read on the topic.

After over a decade working in healthcare, I can also say that most of the errors I've seen are due to miscommunication. In surgery, there are plenty of close calls due to errors in the charts that are caught during a time out. The majority are as insignificant as a patient stating they're allergic to something environmental when the chart says "no allergies," but I've actually witnessed a chart saying "left knee" when we we're operating on the right knee. It's also not as uncommon as you'd like to think for the wrong patient to be brought into a room for a procedure, or a medication error to occur when someone who isn't licensed drawing up medications incorrectly. Many outpatient centers aren't strict about labeling medications, either. You have to trust the people you're working with, and don't take anything for granted. Most errors are so insignificant that they go unnoticed, but the rest are destructive.

 

[The Knife & Gun Club]

Greetings, everyone!

I read online a report not too long ago that claimed that Human Medical Errors was the #3rd cause of death in the United States.

Although we are all prone to mistakes considering no one is perfect, doesn't anyone find this concerning? I am not in med school by any means, but many former and current med students have told me that in med school that they throw so much info out at you that it's impossible to know all of it. As a result, students make themselves sick due to anxiety and are more predisposed towards developing depression, thus, hindering academic and mental performance. The saying "one week of med school is equivalent to one undergraduate semester" is agreed upon by many med students. By what these students are telling me about how much hell it all is, how is that even doable? I get people's lives are on the lines, but how can someone properly retain all of this information when they have little time to absorb it? Maybe this is the issue contributing towards human medical errors? Thoughts?

Great question! People above touched a lot of good points. I just wanted to add that also a lot of what is learned in medical school doesn't need to be retained VERBATIM to prevent errors. Using the Brachial Plexus example, it's very important to know generally how the brachial plexus breaks up nerve imput into your arm. But it's not critical to remember exact the name of a certain cord or division at a moments notice in most arenas. You know the general concept, and if you need to know the specifics you look it up to refresh.

 

[Ismet]

I'm not saying a fundamental understanding of anatomy and physiology isn't helpful and indeed oftentimes required for certain aspects of medicine, but the fact of the matter is that a large portion of the details you don't use in your day-to-day practice will be pruned away over the years as a physician. There's simply no way around it. You even said it yourself, @cbrons, a physician must know, at a baseline, SIMPLE physiology...Of course we will all know about gas exchange and basic hemodynamics, but virtually nobody will remember that UDP-glucoronosyl-transferase converts unconjugated bilirubin albumin complex to conjugated bilirubin. Unless you're some kind of Rainman, there's no way in hell you're remembering that stuff as an attending...because 99% of the time, there is simply no need.

Pretty common pimp question on peds for physiologic jaundice in a newborn. 😛

 

[Ismet]

Great question! People above touched a lot of good points. I just wanted to add that also a lot of what is learned in medical school doesn't need to be retained VERBATIM to prevent errors. Using the Brachial Plexus example, it's very important to know generally how the brachial plexus breaks up nerve imput into your arm. But it's not critical to remember exact the name of a certain cord or division at a moments notice in most arenas. You know the general concept, and if you need to know the specifics you look it up to refresh.

Basically residency. Had myself a little refresher on AKI last night.